Individual
DR. MINI SIVADASAN I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3430 WHEATLAND RD BUILDING 1 SUITE 202, DALLAS, TX 75237-7523
(972) 780-5888
(972) 780-5886
Mailing address
3430 WHEATLAND RD PAV I STE 202, DALLAS, TX 75237-5031
(972) 780-5888
(972) 780-5886
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
01068886A
IN
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
036126598
IL
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
55502-20
WI
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
S1921
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01618941
BLUECROSS/BLUESHIELD IL
IL
05
—
036126598
—
IL
05
—
1336330570
—
MI
05
—
1336330570
—
WI
05
—
201014710A
—
IN
05
—
201014710B
—
IN
05
—
201014710C
—
IN
05
—
201014710D
—
IN
05
—
201014710E
—
IN
Enumeration date
08/05/2007
Last updated
11/27/2023
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